Cardiovascular System Diseases and Disorders Chapter 8 Cardiovascular System Diseases and Disorders 1

Anatomy and Physiology Cardiovascular system Heart, arteries, and veins with blood Heart Size of man’s fist Located slightly left of the middle of the chest Composed of cardiac muscle, 4 chambers, 4 valves 2

The Heart 3

Anatomy and Physiology Heart: Wall of heart has three layers Epicardium Myocardium Endocardium 4

Common Signs and Symptoms Chest pain Shortness of breath Tachycardia Cardiac palpitations 5

Diagnostic Tests Noninvasive procedures: Auscultation Doppler Arterial blood pressure Electrocardiogram Echocardiography PET scan 6

Diagnostic Tests Cardiac catheterization X-rays Invasive procedure to determine oxygen content and blood pressure X-rays To determine normal function of heart and vessels 7

Diagnostic Tests Common X-rays: Blood tests Angiocardiography Angiography Venogram Blood tests Enzymes Creatine phosphokinase (CPK) Lactate dehydrogenase (LDH) 8

Diseases of the Cardiovascular System Cardiovascular disease CVD Leading cause of death in the United States High blood pressure is common cause 9

Diseases of Arteries Hypertension Indicator of development of cerebrovascular, cardiovascular, and kidney disease Chronic disease Leading cause of stroke and heart failure 10

Diseases of Arteries Hypertension Normal blood pressure 120/80 Top number (systolic) Measures highest pressure in artery when ventricles contract Bottom number (diastolic) Measures pressure in artery when ventricles relax High blood pressure Greater than 140/90 11

Diseases of Arteries Hypertension Primary Risk factors: Idiopathic with gradual onset Also known as essential hypertension Risk factors: Heredity Diet Age Obesity Smoking Stress 12

Diseases of Arteries Hypertension Treatment: Antihypertensive medications Lifestyle changes Low-salt diet Stress-reducing exercise Smoking cessation Diuretics 13

Diseases of Arteries Arteriosclerosis and atherosclerosis Loss of elasticity and thickening of artery wall Also known as hardening of arteries Plaque Deposits of fatty or lipid material in wall of artery 14

Diseases of Arteries Atherosclerosis Major areas affected: Coronary arteries Cerebral arteries Aorta Peripheral arteries 15

Diseases of Arteries Atherosclerosis Risk factors: Noncontrollable factors Heredity Age Sex Diabetes 16

Diseases of Arteries Atherosclerosis Risk factors: Controllable factors Diet Sedentary lifestyle Cigarette smoking Stress Hypertension 17

Diseases of Arteries Atherosclerosis Diagnosis by blood pressure, arteriograms, X-rays, and Doppler Symptomatic treatment: Bypass surgery of occluded arteries and plaque removal 18

Diseases of Arteries Peripheral vascular disease (PVD) Caused by atherosclerotic plaque in arteries supplying blood to legs Intermittent claudication Muscle cramps relieved with rest and increased with activity 19

Diseases of Arteries Peripheral vascular disease (PVD) Treatment: Endarterectomy If necrosis occurs, amputation or resection may be necessary 20

Diseases of Arteries Aneurysm Weakening in wall of artery leading to bulge or rupture Usually asymptomatic and discovered accidentally Aorta Most common location Treatment: Repairing aneurysm before rupture through resection and grafting 21

Types of Aneurysms 22

Diseases of Arteries Coronary artery disease Narrowing of arteries that supply blood to myocardium Single leading cause of death in United States Commonly due to atherosclerosis 23

Diseases of Arteries Coronary artery disease Progressive narrowing of vessels may lead to ischemia of heart muscle and symptoms Scar tissue replaces muscle Occlusion may progress slowly or suddenly as result of thrombus or embolus 24

Diseases of Arteries Coronary artery disease Myocardial infarction Death of heart muscle Diagnosis by history, electrocardiogram (ECG), and angiograms Treatment: Aimed at increasing blood flow or decreasing oxygen needs 25

Diseases of Arteries Coronary artery disease Treatment: Angina treated with vasodilators Angioplasty Coronary artery bypass graft (CABG) Reduction of atherosclerotic risk factors Diet Exercise Smoking 26

CABG 27

Diseases of the Heart Angina pectoris Chest pain Lack of oxygen to heart Sign of impending myocardial infarction Treatment: Decrease workload of heart Use nitroglycerin 28

Diseases of the Heart Myocardial infarction Heart attack Occurs when heart does not get enough oxygen Symptoms: Severe chest pain with diaphoresis and nausea Referred pain to neck, arm, and jaw with discomfort similar to bad or unrelieved indigestion 29

Diseases of the Heart Myocardial infarction Treatment: Give immediate attention to prevent shock Relieve respiratory distress Decrease workload If cardiac arrest, cardiopulmonary resuscitation (CPR) must be performed 30

Diseases of the Heart Myocardial infarction Treatment: Oxygen and pain medication Medications to treat arrhythmias Clot-busting medications Education on prevention by lifestyle changes Smoking cessation Diet Exercise 31

Diseases of the Heart Hypertensive heart disease Result of long-term hypertension Causes: Disease or disorder causing chronic elevation in blood pressure Treatment: Treat cause of hypertension Can only be controlled No cure 32

Diseases of the Heart Rheumatic heart disease Autoimmune disorder caused by streptococcal throat infection All layers of heart and valves can be affected Treatment: Prevention/treatment of streptococcal infections Rest during acute stage Valve replacement to correct deformity 33

Diseases of the Heart Congestive heart failure (CHF) Heart fails to pump adequate blood supply Develops slowly and increases workload of heart Symptoms: Gradual increase in dyspnea Tachycardia Tachypnea 34

Diseases of the Heart CHF Symptoms: Neck vein distention Edema in ankles and lower legs Right-sided leads to congestion of liver and spleen Left-sided leads to congestion of lungs 35

Diseases of the Heart CHF Diagnosis by history and physical, chest X-ray, and ECG Treatment: Decrease workload Diuretics Salt and fluid restrictions Medications to strengthen and slow heart E.g., digitalis 36

Diseases of the Heart Cardiomyopathy Disease of heart muscle Characterized by dilated, enlarged, thin, flabby heart muscle No cure Leads to CHF, myocardial infarction, and death 37

Diseases of the Heart Carditis Inflammation of heart E.g., pericarditis, myocarditis, endocarditis Often secondary to respiratory, urinary tract, or skin infection Treatment: Rest Antibiotics Analgesics Antipyretics 38

Diseases of the Heart Valvular heart disease Malfunction of heart valves Murmurs or abnormal heart sound Causes: Congenital abnormalities or malformations Rheumatic fever Endocarditis 39

Diseases of the Heart Arrhythmias Abnormal heart rhythm Sinus rhythm is normal heart rhythm 60 to 100 beats per minute Flutter Unusually fast heart rate Fibrillation Wild and uncoordinated Heart block Interruption in conduction system 40

Diseases of the Heart Arrhythmias Divided into first-, second-, or third-degree Premature or early contractions (PVCs) may affect atria or ventricles Treatment: Unnecessary if asymptomatic 41

Diseases of the Veins Phlebitis Inflammation of superficial veins Symptoms: Pain Swelling Red, cord-like hardening along vein toward heart 42

Diseases of the Veins Phlebitis Treatment: Analgesics Warm compresses Elevation of area above heart level Elastic stockings Exercise 43

Diseases of the Veins Thrombophlebitis Clotting in vessels of legs, thighs, and pelvis Asymptomatic until embolization occurs Risk factors: Immobility Dehydration Varicose veins Leg/pelvic surgery, obesity, pregnancy 44

Phlebitis and Thrombus 45

Diseases of the Veins Deep vein thrombosis (DVT) Treatment: Reduce clot Prevent embolization Use anticoagulants 46

Diseases of the Veins Varicose veins Dilated, tortuous, and elongated veins in legs Causes: Prolonged sitting or standing Pregnancy Obesity 47

Diseases of the Veins Varicose veins Symptoms: Treatment: Leg fatigue and cramps Thickening veins Edema Fluid Treatment: Elevate legs Walk Use support or elastic hose Strip vein 48

Trauma Hemorrhage Abnormal loss of blood May be acute or chronic Exsanguination Loss of circulating blood Internal bleeding can lead to anemia or shock due to blood loss 49

Trauma Hemorrhage Low-pressure vessels lead to petechiae or ecchymosis of purpura High-pressure vessels lead to squirting of bright red blood 50

Trauma Shock Extremely low blood pressure that leads to decreased tissue perfusion Types: Cardiogenic Septic Hypovolemic Neurogenic Anaphylactic 51

Trauma Shock Symptoms: Facial pallor Cool and clammy skin Cyanosis Tachycardia Tachypnea Altered mental status Syncope Unconsciousness Oliguria or anuria 52

Trauma Shock Treatment: Rest in supine position Move to warm, quiet environment Elevate feet and legs above heart 53

Rare Diseases Malignant hypertension Cor pulmonale Raynaud’s disease Buerger’s disease Polyarteritis nodosa 54

Effects of Aging Decreased contractility of heart muscle Decreased elasticity of vessels Thickening of valves Becoming sclerotic 55